Biomedical subjects

Peter J Cunningham

Publications and source records attributed to Peter J Cunningham.

18 recordsLinked to original sources

PubMed2006

What accounts for differences in the use of hospital emergency departments across U.S. communities?

Increases in the use of hospital emergency departments (EDs) might contribute to crowding at some EDs, higher health care costs, and lower-quality primary care. This study examines the extent to which differences in populations and health system factors account for variations in ED use across U.S. communities. Contrary to popular perceptions, communities with high ED use have fewer numbers of uninsured, Hispanic, and noncitizen residents. Outpatient capacity constraints also contribute to high ED use. However, high ED use in some communities also likely reflects generic preferences for EDs as a source of care for nonurgent problems.

Emergency Service, Hospital↗

PubMed2006

A growing hole in the safety net: physician charity care declines again.

Continuing a decade-long trend, the proportion of U.S. physicians providing charity care dropped to 68 percent in 2004-05 from 76 percent in 1996-97, according to a national study from the Center for Studying Health System Change (HSC). The ongoing decline in physician charity care is alarming given the increase in the number of uninsured people, particularly during the first half of the decade. Declines in charity care were observed across most major specialties, practice types, practice income levels and geographic regions. Increasing financial pressures and changes in practice arrangements may account in part for the continuing decrease in physician charity care.

Forecasting↗

PubMed2005

The effects of medicaid reimbursement on the access to care of medicaid enrollees: a community perspective.

Previous research has not found a strong association between Medicaid reimbursement levels and enrollees' access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees' access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician Medicaid acceptance in an area. Numerous other physician practice, health system, and community characteristics also affect Medicaid acceptance. The effects of Medicaid fees on Medicaid acceptance are substantially lower in areas with high Medicaid managed care penetration and for physicians who practice in institutional settings. The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees.

Data Collection↗

PubMed2005

Balancing margin and mission: hospitals alter billing and collection practices for uninsured patients.

A barrage of publicity about aggressive hospital billing and collection practices and a spate of lawsuits alleging hospitals overcharged uninsured patients have put hospitals in a harsh national spotlight. In the wake of a campaign by hospital associations to encourage hospitals to create formal policies for billing uninsured patients, many hospitals have modified billing and collection practices for low-income, uninsured patients, according to the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. Almost all of the hospitals interviewed that had adopted more generous charity care policies indicated expenses previously classified as bad debt have shifted to charity care write-offs. To date, these changes have had little impact on hospital bottom lines, and the impact on access to care for uninsured people remains unclear.

Accounts Payable and Receivable↗

PubMed2005

Perception, reality and health insurance: uninsured as likely as insured to perceive need for care but half as likely to get care.

While considerable research shows that uninsured people are less likely to seek and receive medical care, some contend that the uninsured are uninsured by choice and can obtain care when needed. A new study by the Center for Studying Health System Change (HSC), however, undercuts the validity of this contention, finding that there is no difference between insured and uninsured people's perception of the need to see a medical provider when they experience a serious new symptom. However, among people who believed that they needed medical care, the uninsured were less than half as likely to see or talk to a doctor, indicating that lack of insurance is a major barrier to uninsured people getting needed medical care.

Adult↗

PubMed2004

Tough trade-offs: medical bills, family finances and access to care.

About 20 million American families-representing 43 million people-reported problems paying medical bills in 2003, according to a new study by the Center for Studying Health System Change (HSC). While uninsured families are more likely to have medical bill problems, two-thirds of families with problems paying medical bills have health insurance coverage. Of all families with medical bill problems, almost two-thirds reported difficulty paying for other basic necessities-rent, mortgage payments, transportation or food-as a result of medical debt. People in families with medical bill problems also reported much greater trouble getting care because of cost concerns-one in three did not get a prescription drug, one in four delayed care and one in eight went without needed care.

Bankruptcy↗

PubMed2004

Trends in Americans' access to needed medical care, 2001-2003.

Despite sluggish economic growth and rapidly rising health care costs, Americans' access to needed medical care improved between 2001 and 2003, especially among low-income children and adults, according to findings from the Center for Studying Health System Change's (HSC) nationally representative Community Tracking Study Household Survey. In particular, the proportion of low-income, uninsured Americans who reported going without needed medical care fell by 3.2 percentage points to 13.2 percent in 2003, and unmet medical needs for low-income children decreased to the point where income-related differences in access to care for children have disappeared. Nonetheless, about one in seven Americans reported difficulty obtaining needed care in 2003, and people reporting access problems increasingly cited cost as a barrier to care.

Adult↗

PubMed2004

Most uninsured people unaware of health care safety net providers.

Less than half of uninsured Americans either typically use or are aware of a safety net provider in their community, according to a national study by the Center for Studying Health System Change (HSC). Among all uninsured people, those with lower-incomes, racial/ethnic minorities and people living closer to safety net providers are more likely to know of or use a safety net provider for medical care. Uninsured people identify physician offices and community health centers most frequently as sources of lower-cost medical care, while hospital-based facilities--outpatient and emergency departments--are less likely to be mentioned. Despite high levels of emergency department (ED) use by uninsured people, few identify EDs as places to get affordable medical care.

Community Health Centers↗

PubMed2002

The effects of SCHIP on children's health insurance coverage: early evidence from the community tracking study.

The State Children's Health Insurance Program (SCHIP) was designed to increase the number of children with health insurance coverage without resulting in large numbers of children substituting public coverage for private insurance. This study uses data from the Community Tracking Study collected before and after SCHIP implementation to examine the effects of increases in eligibility for public coverage on children's health insurance coverage. Using a regression-based difference-in-differences approach, the authors find that increases in eligibility for public coverage did increase the likelihood of having Medicaid or other state coverage versus being uninsured for the primary SCHIP target population--children in families with incomes between 100 and 200 percent of the federal poverty level. However, eligibility increases also increased the likelihood of having public coverage versus private insurance for this income group, indicating that SCHIP expansions resulted in substitution of public for private insurance. In fact, simulation results indicate that the initial impact of SCHIP on private insurance coverage has been far greater than on uninsurance rates. These results reflect the early stages of SCHIP implementation, however, and are subject to change as the SCHIP programs mature.

Adolescent↗

PubMed2002

Declining employer-sponsored coverage: the role of public programs and implications for access to care.

Using data from the 1996/1997 Community Tracking Study household survey, this study examines the effects of public programs on the decision to take up employer coverage when offered versus enrolling in public coverage or being uninsured. The results show that among those with access to employer-sponsored coverage, low-income persons living in states with more expansive eligibility for Medicaid were more likely to decline employer coverage in favor of public coverage, while low-income persons in areas with public hospitals were more likely to decline coverage in favor of being uninsured. While persons who decline employer coverage in favor of public coverage maintain the same level of access to medical care, those who decline coverage in favor of being uninsured give up a considerable degree of access. Implications concerning policies to improve access to care for the uninsured are discussed.

Adult↗

PubMed2002

Prescription drug access: not just a Medicare problem.

While all state Medicaid programs provide outpatient prescription drug coverage, slightly more than one in four Medicaid patients ages 18-64 could not afford to fill at least one prescription in the last year, according to a new study by the Center for Studying Health System Change (HSC). A similar percentage of uninsured adults also had difficulty affording prescription medications. Faced with rapidly rising drug spending, many states have moved to control Medicaid prescription drug spending by imposing copayments, limiting the number of prescriptions and using other cost-containment methods. The study indicates that these state cost-control measures are contributing to Medicaid beneficiaries' prescription drug access problems. State and federal policy makers should keep in mind that the impact of these controls on Medicaid beneficiaries is likely to be greater than on privately insured people, given their higher need and lower incomes.

Adult↗

PubMed2002

SCHIP, Medicaid expansions lead to shifts in children's coverage.

Recent expansions of the State Children's Health Insurance Program (SCHIP) and Medicaid have led to significant shifts in insurance coverage for children. New findings from the Center for Studying Health System Change (HSC) show that the proportion of low-income children who were uninsured dropped from 20.1 percent in 1997 to 16.1 percent in 2001, a result of significant increases in public program coverage. The net effect of these gains in coverage was limited, however, by a decline in private insurance coverage (from 47% in 1997 to 42.3% in 2001). The drop in private insurance was due, in part, to substitution of public for private insurance coverage.

Budgets↗

PubMed2002

Treading water: Americans' access to needed medical care, 1997-2001.

Despite unprecedented economic growth, low unemployment and fewer uninsured people, Americans' ability to get needed medical care failed to improve significantly between 1997 and 2001, according to findings from the Center for Studying Health System Change's HSC) Community Tracking Study Household Survey. While most people get the care they believe they need, about one in seven Americans reported some difficulty obtaining needed care in 2001 - about the same as in 1997. At the same time, health system-related problems - such as the ability to get timely appointments - increased, suggesting possible health system capacity constraints are emerging. On a brighter note, children's ability to get needed care improved.

Adult↗

PubMed2002

Mounting pressures: physicians serving Medicaid patients and the uninsured, 1997-2001.

The proportion of doctors providing any charity care decreased from 76.3 percent in 1997 to 71.5 percent in 2001, according to a new study by the Center for Studying Health System Change (HSC). The proportion of physicians serving Medicaid patients also decreased from 87.1 percent in 1997 to 85.4 percent in 2001. The small decrease in physicians serving Medicaid patients does not appear to have had any negative effects on access to physicians among Medicaid beneficiaries. On the other hand, the more sizable decrease in physicians providing charity care is consistent with other evidence showing decreased access to physicians by uninsured persons. New budget pressures could lead states to freeze or cut Medicaid provider payment rates, which could then trigger access problems.

Forecasting↗

PubMed2001

Targeting communities with high rates of uninsured children.

Data from the first two rounds of the Community Tracking Study household survey show that coverage expansions through the State Children's Health Insurance Program (SCHIP) have virtually eliminated differences across communities in children's eligibility for public or private health coverage. Nevertheless, some communities continue to have very high rates of uninsured children, in large part because of lower participation rates in public programs and higher costs for employer-sponsored coverage. Participation in SCHIP may increase in high-uninsurance communities as the new programs mature, although low participation rates in public programs prior to SCHIP suggest that enrollment barriers may still be greater in such communities.

Adolescent↗

PubMedDate not supplied

SCHIP making progress: increased take-up contributes to coverage gains.

Previous research based on the Community Tracking Study (CTS) showed that while coverage expansions through the State Children's Health Insurance Program (SCHIP) greatly increased children's eligibility for public or private health insurance coverage, uninsurance rates remained unchanged because of low take-up by eligible children. However, more recent data show that this is changing. Children's uninsurance rates decreased sharply between 1999 and 2001; these changes were greatest in communities where take-up rates have traditionally been the lowest and uninsurance rates the highest. Although uninsurance rates still can be decreased further, state budget pressures threaten the momentum toward higher participation in public programs.

Child↗

PubMedDate not supplied

Medicaid cost containment and access to prescription drugs.

States have been intensifying their efforts to control rising prescription drug costs in their Medicaid programs. This study examines the effects of five Medicaid cost containment policies on enrollees' perceptions of their ability to get prescription drugs. The results show that enrollees in states that have implemented all or almost all of these five policies have greater problems getting prescription drugs than enrollees in other states encounter. In terms of specific policies, prior authorization and mandatory generic substitutions had the largest effects on access to prescription drugs.

Adolescent↗

PubMedDate not supplied

Medicaid/SCHIP cuts and hospital emergency department use.

This paper uses data from the 2000-01 and 2003 Community Tracking Study household surveys to examine how decreases in enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP) and increases in the number of uninsured people would affect the volume and distribution of emergency department (ED) use among low-income people. A decrease in Medicaid/SCHIP enrollment would lead to an increase in ED visits by the uninsured but little change in overall ED volume. The results suggest that cost containment efforts that reduce eligibility and enrollment will achieve cost savings largely by reducing access and shifting costs away from Medicaid/SCHIP.

Adolescent↗